Time course of the increase in airway responsiveness associated with late asthmatic reactions to toluene diisocyanate in sensitized subjects

To understand better the mechanism of the increase in airway responsiveness associated with late asthmatic reactions, we determined the time course of toluene diisocyanate (TDI) effect on airway responsiveness in six sensitized subjects who exhibited a late asthmatic response after TDI exposure (0.018 +/- 0.005 ppm, 30 min) in the laboratory. Airway responsiveness was assessed before TDI exposure and then at 8 hr, 1 day, 1 wk, and 1 mo after TDI exposure. To assess responsiveness we determined the provocative dose of methacholine causing a decrease in FEV1 of 20% (PD20FEV1). The methacholine PD20 decreased from 0.50 mg geometric standard error of the mean (GSEM = 1.54) to 0.06 mg (GSEM = 1.55) (p less than 0.001) at 8 hr after exposure to TDI, was still decreased to 0.15 mg (GSEM = 1.93) (p less than 0.05) at 1 day, returned to 0.26 mg (GSEM = 1.91) (p greater than 0.05) at 1 wk, and returned to 0.43 mg (GSEM = 1.71) at 1 mo, indicating that full recovery occurred within 1 to 4 wk. These results demonstrate that TDI-induced late asthmatic response is associated with a reversible increase in airway responsiveness to methacholine and suggest that the TDI effect is linked to an acute inflammatory response in the airways.     

YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis

BackgroundReal-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates.ObjectiveThe purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures.MethodsWe searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique.ResultsIn all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat–related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020).ConclusionsOur findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.     

颅内肿瘤的CT误诊分析

目的　分析颅内肿瘤的CT误诊原因 ,提高颅内肿瘤的CT诊断水平。方法　回顾分析经病理证实、CT误诊的 17例颅内肿瘤的CT图像资料 ,并与病理学结果进行对照。结果　CT误诊的 17例包括脑膜瘤 7例 ,胶质瘤 7例 ,颅咽管瘤 1例 ,垂体瘤 1例 ,多发颅内肿瘤1例。病变征象不典型、对病变CT征象认识不足和观察不仔细、检查方法不当、诊断思维错误、机器因素等是造成CT误诊颅内肿瘤的主要原因。结论　加强对病变CT征象的认识 ,培养客观正确的诊断思维 ,选择恰当的扫描方式 ,有助于减少或避免颅内肿瘤的CT误诊。     

差错反感文化在护士内部人身份认知与道德勇气间的中介作用

目的 探讨差错反感文化对护士内部人身份认知与道德勇气的影响及机制,为提高其道德勇气提供依据.方法 抽取湖南省湘西自治州7所二级医院的693名护士,采用一般资料调查表、差错反感文化量表、内部人身份认知量表及道德勇气量表进行调查.结果 护士的差错反感文化、内部人身份认知、道德勇气总分分别为(26.05±4.92)分、(27.99±3.15)分、(84.28±9.48)分.差错反感文化与道德勇气呈负相关,内部人身份认知与道德勇气呈正相关(均P＜0.01),差错反感文化在内部人身份认知与道德勇气间发挥部分中介作用,间接效应占总效应的15.74％.结论 护士的道德勇气总体水平较高,可以通过合理管理差错反感文化、增强内部人身份认知来提高护士道德勇气.     

串联质谱技术在脂肪酸氧化代谢病诊断中的应用研究

目的探讨利用串联质谱技术检测干血滤纸片中酰基肉碱水平,诊断脂肪酸氧化代谢病。方法对象为2941例临床遗传性代谢病高危儿童,利用串联质谱技术检测患儿干血滤纸片中酰基肉碱水平,结合临床资料和常规生化结果,进行脂肪酸氧化代谢病诊断。结果诊断了14例脂肪酸氧化代谢病(0.5%),其中肉碱棕榈酰转移酶Ⅰ缺乏症1例,肉碱棕榈酰转移酶Ⅱ缺乏症1例,短链酰基辅酶A脱氢酶缺乏症1例,中链酰基辅酶A脱氢酶缺乏症7例,极长链酰基辅酶A脱氢酶缺乏症2例,多种酰基辅酶A脱氢酶缺乏症2例。结论通过串联质谱技术检测干血滤纸片中酰基肉碱水平,可对部分脂肪酸氧化代谢病进行诊断。     

PRK治疗RK后残余近视散光二年疗效分析

目的： 评价准分子激光屈光性角膜切削术治疗放射状角膜切开术后残余近视散光的预测性、稳定性和安全性。方法： 对５２ 眼 Ｒ Ｋ 术后残余近视散光患者行再次 Ｐ Ｒ Ｋ 治疗, 并连续随访两年以上。术前残余球镜屈光度－ ３７５±１３２ Ｄ,残余柱镜屈光度－ ２３６±１２５ Ｄ, 最佳矫正视力均≥０８。结果： 术后 ６ 个月球镜屈光度－ ０３２±０２４ Ｄ, 柱镜屈光度－ ０７８±０５２ Ｄ, 裸眼视力≥１０ 者４６ 眼 （８８４６％ ）, 术后 ２４ 个月球镜屈光度－ ０３７±０４２ Ｄ, 柱镜屈光度－ ０５６±０３７ Ｄ, 裸眼视力≥１０ 者 ４２ 眼 （８０７６％ ）。最佳矫正视力下降 １ 行以上者 ３ 眼 （５７６％ ）, 实际球镜矫正度与预期矫正度相差１０ Ｄ 以内 ５０ 眼 （９０１５％ ）, 柱镜相差 １０ Ｄ以内５１ 眼 （９８０７％ ）。结论： Ｐ Ｒ Ｋ 治疗 Ｒ Ｋ 术后残余近视散光的两年随访结果表明, 该方法预测性强、稳定性好和安全性高, 特别在矫正残余散光方面, 其结果令人满意。     

Risk assessment in clinical pharmacy

Medication error forms a major proportion of the errors in the medical system. Despite many studies of adverse drug events, there are no systematic ways of ensuring safety, or of assessing how safe a pharmaceutical system is. Risk assessment is required in hazardous industries such as nuclear power or oil and gas. Risk assessments involve identifying the defences and assessing their effectiveness and are relatively uncommon in clinical pharmacy , as opposed to reactive approaches involving incident analyses. Risk factors, that degrade barriers, can be identified and their effect measured. A risk assessment structure for pharmacy processes is proposed that can also be used to support incident investigation and analysis processes and provide a standard for audit.     

放射治疗中的摆位误差

随着放射治疗向高精度方向发展 ,研究放射治疗中的摆位误差具有重要意义。就摆位误差的定义、来源、表示方法、测量予以综述 ,并总结了以往的研究数据 ,提出临床工作中需注意的问题。     

PATHOLOGY OF LONG-CHAIN 3-HYDROXYACYL-COA DEHYDROGENASE DEFICIENCY CAUSED BY THE G1528C MUTATION

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency is a recently discovered disorder affecting the mitochondrial-oxidation of fatty acids. There have been few reports of the pathologic findings in-oxidation defects. We examined pathologic specimens from 16 patients with this disorder (11 patients were homozygous for the common mutation G1528C, 5 patients were siblings with a similar clinical presentation). Autopsies were performed on all 15 patients who died, and liver biopsy specimens were available from 8 patients. Hepatomegaly and steatosis of the liver, found in every patient, were often combined with fibrosis or cirrhosis. Cardiomegaly and accumulation of fat in the myocardium, renal tubules, and skeletal muscle were found in many patients. A detailed neuropathologic examination was performed on six patients, and brain specimens obtained at autopsy were examined in four others. In general, neuropathologic findings were mild and unspecific, but vacuolization was detected in the deep gray matter and in the cerebellum and brain stem nuclei of five patients. In one patient the vacuolization was prominent; in the other four it was milder and more focal. The vacuoles seemed to be either in the neuropil or associated with swollen hydropic cells. The uniform pattern of histopathologic changes facilitates the diagnostics in this severe disorder, allowing opportunities for therapy and prenatal diagnosis.